“We have a patient with an odd infection of the face and neck and want to know what antibiotics to start” said the ENT Doctor.
 
“What do you mean by odd?” asked the Microbiologist vaguely, distracted by all of the requests for coronavirus testing that where sitting in the laboratory.
 
“Well the patient has bilateral swelling of her face and neck and difficulty swallowing, and it’s a bit odd to be bilateral”.
 
The Microbiologist perked up and started to pay more attention.
 
“What does she do? Has she injured herself recently? Does she have pain on opening her mouth? What’s her vaccination history?” he asked.
 
“Errrr. She’s retired. We haven’t asked about injuries. She can’t open her mouth. She’s 77 years old so we haven’t asked about vaccines” answered the ENT Doctor.
 
“Okay. Go and ask her the questions. More specifically is she a keen gardener? Has she had any injuries, however minor, which might have been contaminated with soil or manure? When did she last have a tetanus immunisation? I’ll stay on the phone while you ask. This sounds like it might be tetanus”.
 
There was a pause, then the sound of the phone being put down on the desk, whilst the ENT Doctor went off to get some answers…
 
The Microbiologist tapped his desk nervously, “see, see not all patients are presenting with Covid-19, and I do wonder how many “ordinary” illnesses are being overlooked amongst the Covid-19 shenanigans…”
 
The ENT Doctor returned to the phone and asked … “are you still talking to me?”
 
“Oh umm, no I’m just ranting a little to myself” replied the Microbiologist.

“We have a lady with puerperal fever. She’s 2 days post-delivery and pretty unwell. Critical Care are reviewing her now and we’d like some advice about the best antibiotics to give her” said the Obstetrics Registrar.
 
Excellent thought the Microbiologist; they’re being proactive about a serious problem.
 
“If she’s not allergic to anything then IV Benzylpeniciilin and Clindamycin. Have you looked for retained products and done a DNC?” asked the Microbiologist.
 
“She’s really unwell, we don’t really want to take her to theatre. We might damage the uterus” replied the Registrar.
 
“She’s unlikely to improve if you don’t,” said the Microbiologist sympathetically. “You need to remove as much infected material as you can. I know it sounds brutal but it’s really important”.
 
“Okay,” said the Registrar sounding doubtful, “my Consultant is with the patient at the moment so I’ll go and tell them what you have advised. Thanks for your help.”
 
The Microbiologist put down the phone and put down his pen. Time to visit the obstetric ward and see what is going on…

It’s all over the news; a new deadly plague is spreading across the World in an unstoppable wave of death and disease! Cities are falling, governments are collapsing, mass panic and chaos are ensuing… or at least that’s what the media would have us believe about the novel coronavirus from Wuhan in China. Gosh, it’s reminding me of the game of Pandemic!

“I’ve got a tricky one for you” said the Respiratory Consultant.
 
“Go on then, tell me what you’ve got” replied the Microbiologist, knowing from previous experience that this would indeed be a tricky case, but looking forward to his colleagues challenge.
 
“I’ve got an elderly chap who has bronchiectasis and I have been treating for an exacerbation without much luck. In fact he’s getting worse. Despite 2 weeks of different IV antibiotics his CT shows progressive cavitation. He has lost a lot of weight over the past couple of months and unless we come up with something I think I’m going to lose this battle”
 
As the discussion went on the Microbiologist started to look at the patients past results. The one bacterium that stood out as being a bit unusual was Mycobacterium abscessus which had grown a few times over the past year in various sputum samples.
 
“Mmmm, what do you think about the M. abscessus?” asked the Microbiologist. “It sounds like this may be more significant than we’d normally give it credit for.”
 
“I’m glad you say that, I thought the same, but didn’t want to influence your thoughts” replied the Respiratory Consultant.
 
“Mmmm, I have only rarely seen it cause clinical disease, although it’s improbable, it is possible, so let me check the latest literature and I’ll meet you on the ward and we’ll go from there” said the Microbiologist already opening a large tome of reference text, muttering to himself …this isn’t going to be covered in Microbiology Nuts & Bolts!!

It’s that time of year… no, not Christmas! In our house it’s Dentist time! While training I was told by a wise veterinary friend that “Doctors shouldn’t treat pets or teeth; they’re not vets or dentists…” and after a course of “stored-up” Metronidazole hadn’t helped my “sensitive tooth” my routine check-up visit has turned into “a repair appointment”. I should have taken my friend’s excellent advice…my issue was not an infection and my abilities in dental diagnosis are clearly lacking! However as Microbiologists we are allowed to consider the causes of dental infections and how they might lead to patients needing antibiotic treatment or even being admitted to hospital.
 
“What time did you go to the Dentist?”
 
“Two thirty” (Ha ha Tooth hurty, tee hee!)

The Microbiologists were out having their Christmas curry together when the oncall phone twitched into action. Looking around the table, under pulled crackers and wrapping paper, the oncall Microbiologist (the only one not drinking!) took the call while the others ordered some more drinks and food… It was a noisy gathering as Microbiologists don’t get out much…
 
The waiter looked expectantly to take more drinks orders….
 
“I’m sure she said a mango lassie, I’ll get her one …yes… one mango lassie please and five cobra beers and another taka dahl, thanks”. The waiter scuttled off.
 
“I ordered you the mango lassie” said the (tipsy off duty) Microbiologist
 
“Why did you get me a lassie?” asked the oncall Microbiologist.
 
“You said mango lassie while on the phone… when we were ordering more drinks… didn’t you!?!”
 
“No… that was the Med Reg from the Royal Free, saying they thought one of contacts of the Dutch Lassa fever cases might be transferred to us for follow up and thought we’d like to be aware, as it was in the news and may cause us a call or two if the local media get to know!”… continuing… [and huffing]  “Really… its 10:30 on Friday night, I do not need to know this oncall, but everyone wants their minute of fluster and fame!!” … “Mango lassie…?! You lot need a hearing test or less Cobra beer!” said the oncall Microbiologist.
 
“5 Cobras and a mango lassie…” said the waiter with impeccable timing!
 
The Microbiologists crumpled in laughter and thanked the waiter who just looked puzzled and said he’d bring over the dahl.

The Critical Care ward round was moving slowly. It was a Monday and so most of the patients were new to everyone, including the Microbiologist.
 
The next patient was a middle aged woman who had been intubated and ventilated but who looked otherwise pretty well. [You get a feel for how unwell a patient is just by standing at the end of their bed and observing; equipment, medications, drains and tubes, as well as the colour and appearance of the patient are all clues.]
 
“This lady has Guillain-Barre Syndrome, so no infection issues” said the Critical Care Registrar moving past the end of the bed.
 
Guillain-Barre Syndrome is a rare neurological syndrome of progressive weakness that usually recovers with supportive care. It is thought to be autoimmune in nature.
 
“How did she present?” asked the Microbiologist doing his normal “I’m looking for trouble” kind of thing.
 
Humouring the Microbiologist the Registrar explained that the patient had presented with progressive difficulty swallowing and speaking following an episode of diarrhoea and vomiting. She had become so weak they had needed to ventilate her.
 
“This sounds like sausage poisoning” said the Microbiologist

Well that’s what the Telegraph newspaper says so it must be true!
 
Okay, let’s try and bring this down a peg and look at what is really the story behind the sensationalist headline. Whilst it is sometimes amusing to read these stories, the lack of balance with resulting scare-mongering is frustrating.
 
A study has been performed by Public Health England in association with the National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, looking at the presence of Flaviviruses in deer and deer ticks in the UK. Gosh! What a mouthful, even abbreviated that’s NIHRHPRUEZI, yeah! So we’ll just call them “Liverpool” from now on!!!
 
Anyhow back to the Flaviviruses! Some Flaviviruses cause tick-borne encephalitis (TBE), a condition transmitted by ticks of the Ixodes spp. which usually feed on deer. There are three main types of TBE based upon geographical area:

• European (Scandinavia down to the Adriatic)
• Far-Eastern (Russia, China, Japan)
• Siberian (Siberia and the Baltic)